Overview of Evidence-Based
Self-Management Programs
October 7, 2013
Outline
•
•
•
•
•
Overview of Partners in Care
Chronic Disease Self-Management Programs
Los Angeles Caregiver Resource Centerd
HomeMeds Program
Home Support Program
Mission
To serve as a catalyst for shaping a new vision of health care by
partnering with organizations, families and community leaders
in the work of changing health care systems, changing
communities and changing lives
Partners in Care
Who We Are
Partners in Care is a transforming presence, an innovator and an
advocate to shape the future of health care
We address social and environmental determinants of health to
broaden the impact of medicine
We have a two-fold approach, creating and using evidence-based
models for: provider/system practice change and enhanced patient
self-management
Changing the shape of health care
through new community partnerships
and innovations
Building the New HCBS Services Model: Focus Areas
Evidence-Based Self
Management
Assessments
& Care Coordination
Collaboratives
/Networks/TA
Care Transitions Intervention
Evidence-Based Leadership
Council
Chronic Pain
CBAS Eligibility Determination
Care Coordination Network
Diabetes (billable)
Home Safety Evaluation
Care Transitions Intervention
Network
Chronic Disease
Matter of Balance
Savvy Caregiver
Powerful Tools for Caregivers
Arthritis Foundation Exercise
Arthritis Foundation Walk
with Ease
UCLA Early Memory Loss
HomeMeds
Care Coordination
What is Self-Management?
The actions that individuals living with
chronic conditions must do in order to live a
healthy life.
Physical Activity
Problem-Solving
Medications
Planning
Using Your Mind
Manage Fatigue
Communication
Better Breathing
Healthy Eating
Working with Health
Professionals
Understanding Emotions
Managing Pain
Chronic Disease
Self-Management Education (CDSME)
Program Overview
Evidence based programs developed & licensed by
Stanford University
Patient Education Research Center
Self-Management Programs
• Chronic Disease Self- • Tomando Control
Management*
de su Salud
(Spanish)
• Diabetes
(Eng/Spanish)
• Chronic Pain
*Leader manual available in Arabic, Bengali, Chinese, Dutch, French, German,
Greek, Hindi, Italian, Japanese, Korean, Khmer, Norwegian, Punjabi, Russian,
Somali, Swedish, Tagalog, Tamil, Turkish, Vietnamese
Diabetes Self-Management Program
• Developed at Stanford University by
Kate Lorig, RN, Dr.PH
• Patients with Type 2 diabetes learn to
take charge and control of their
diabetes.
• Develop tools to understand and deal
with:
– Emotions
– Manage medications
– Worth with health care providers
– Make weekly action plans for
exercise and healthy eating
Designed to empower
participants through a mutually
supportive and interactive
education process
Added benefit – socialize with
new people!
Chronic Pain Self-Management Program
• Developed at Stanford University by
Kate Lorig, RN, Dr.PH
• Patients with Primary or Secondary
Diagnosis of chronic pain learn to
manage & lower their chronic pain.
Participants Report:
– Less Pain
– Lower Dependency on Others
– More Energy
– Improved Mental Health
– Increased satisfaction with life
– More involvement in every day
activities
Designed to empower
participants through a mutually
supportive and interactive
education process
Added benefit – develop
relationships with others
suffering from chronic pain!
CDSME Program Goals
To build self-confidence & provide:
Social Interaction
Shared Experiences & Support
Identification of Problems
Reinterpretation of Symptoms
Skill Development to Control Symptoms
Program Design
• 12 -16 participants
– Two Trained Leaders
– People with different conditions

Six-week Program

2 ½ hours, one day a week

Includes:
Group discussions
 Activities
 Short lectures


Book: Living a Healthy Life with Chronic Conditions
Target Population
People with at least one chronic condition
– OR –
A family member, friend or caregiver of
someone with a chronic condition
Stamina to attend 2 ½ hour session
Cognitive function to participate
CDSME Workshop
Participant Health Outcomes
Randomized, controlled trial of 1,000 participants
Increase in
Exercise
Energy
Psychological well-being
Decrease in
Pain and fatigue
Depression
Shortness of Breath
Limitations on Social and role activities
Overall Improved health status &
quality of life
Greater self-efficacy and
empowerment
Enhanced partnerships with
physicians
Sources: Lorig, KR et al. (1999). Med Care, 37:5-14; Lorig, KR et al. (2001). Eff Clin Pract, 4: 256-52;
Lorig, KR et al. (2001). Med Care, 39: 1217-23.
Health Care Utilization Effects
• Results showed more appropriate utilization of
health care resources through decreased:
•
•
•
•
Outpatient visits
Emergency room visits
Hospitalizations
Days in hospital
Ultimate Result:
Reduction in health care expenditures
Testimonials
•
“Because I have been afflicted with Parkinson’s for over 20 years, I have suffered a
great deal of depression. The skills you've taught me in maintaining positive
thinking and combating depression have really helped to improve my condition.” John, age 69
•
“I found the interaction with the other students in the class to be most
enlightening. I realized that although I have a chronic illness I am not alone. Thank
you for all the lessons in helping me to deal with this.” - Suzanne, age 57
•
“The workshop put me back in charge of my life, and I feel great. I only wish I had
done this sooner.” - Robert, age 68
Los Angeles Caregiver
Resource Center (LACRC)
Established in 1989, the LACRC provides information,
support, training and respite assistance to families caregiving
for a person with a brain impairment or chronic condition
residing in Los Angeles county.
This program is one of a network of 11 similar CRCs across
California.
As a program of Partners in Care Foundation, the LACRC helps
identify caregiving individuals and links them with culturally
and linguistically appropriate programs in their communities.
LACRC Programs and Services:
• Information and Referral
• Support Groups (face to face and via the telephone)
• Community Education (weekly or monthly events held in
partnership with senior centers and other community-based
organizations)
• Caregiver Education: Evidence-based programs including Savvy
Caregiver and Powerful Tools for Caregivers workshops.
• Respite Assistance: Limited short –term grants to allow
caregiving individuals to get relief from the many stressors
related to providing care for their loved one.
• Family Consultations: Assistance to caregivers in resolving and
planning for immediate and long term care-related issues.
Care Transitions
• Health reform Section 3026 addresses high
Medicare readmits in 30 days after discharge
• CMS is funding tests of a new Medicare
benefit – 101 nationally and 11 in California
• The hospital partnerships fund CBOs – high
risk are identified and seen in hospital/home
and follow up calls
• Forming a regional delivery system
What a Home Visit Looks Like
• Medication Risk Assessment
– Room by room “Treasure hunt”
– Assessment of possible adverse effects
• Recent falls, dizziness, confusion, BP, pulse
– Assessing client understanding and adherence
• Environmental Assessment
– Safety, cleanliness, maintenance, barriers to mobility
– Evidence of problems
– Fall Risks
22
The Problem- Medication Errors
• Serious: Over 700,000 people go to ED each
year for adverse drug events
• Costly: Drug-related morbidity/mortality >
$170 billion
• Common: Up to 48% of community-dwelling
elders have medication-related problems
• Preventable: At least 25% of all harmful
adverse drug events are preventable
23
Medications Related to Emergency
Hospitalizations
• Frequency and rates of hospitalization after ADE-related
ED visits by older adults aged 65+*
• Nearly half aged 80+
• 2/3 of hospitalizations due to unintentional overdose
• Four medications/classes implicated alone or in combination
in 67% of hospitalizations
– Insulin and hyperglycemic medications
– Anticoagulants & antiplatelets
• High-risk-designated drugs implicated in
1.2% of hospitalizations
*
Emergency Hospitalizations for Adverse Drug Events in Older Americans. Daniel S. Budnitz, M.D., M.P.H.,
Maribeth C. Lovegrove, M.P.H., Nadine Shehab, Pharm.D., M.P.H., and Chesley L. Richards, M.D., M.P.H.
N Engl J Med 2011;365:2002-12
24
The Importance a Home Visit
• Uncovers many “secrets”… that prescribers may
not know about
–
–
–
–
–
–
–
–
–
–
Over-the-counter medications & supplements
Medications prescribed by other providers
Adverse effects such as falls, dizziness, confusion
Assessment information
Incorrect self-dosing
Adherence issues
“Un-manageable care”
$4 co-pays at Wal-Mart < Part D co-pay $
Medications from other countries
Medications “borrowed” from friends and family
25
Evidence-based Protocols
• Protocols identified by national expert consensus panel*
• Target problems that can be identified and resolved in the
home
• Likely to get a positive response by prescribers and
minimize “alert overload”
• Protocols
•
•
•
•
Unnecessary therapeutic duplication
Use of psychotropic drugs in patients with a reported recent fall and/or confusion
Use of NSAID in patients at risk of PUD/gastrointestinal bleeding.
Selected Cardiovascular medication problems
» Sub-optimal blood pressure control
» Orthostatic changes/low systolic BP
» Slow pulse
*"A model for improving medication use in home health care patients " Brown, N. J., Griffin, M. R., Ray, W. A., Meredith, S., Beers, M. H.,
Marren, J., Robles, M., Stergachis, A., Wood, A. J., & Avorn, J. (1998). Journal of the American Pharmaceutical Association, 38 (6), 696-702.
26
Further Evidence
• USC Evaluation in nursing-home eligible communitydwelling population
• Population: 615 Dual Eligibles, 65+
• Social workers & nurses collected data in home visit
• Results ¹ ²
• 49% had potential medication problems
• 29%- pharmacist recommends intervention
• 61% of clients referred to MD after pharmacist review had
medication use improvement
[1] Prevalence of Potential Medication Problems in Dually-Eligible Older Adults in Medicaid
Waiver Services. Alkema GE, Wilber KW, Enguidanos SM, Frey D. An Pharmacotherapy. 12/07
[2] “The Role of Consultant Pharmacists in Reducing Medication Problems Among Older Adults
Receiving Medicaid Waiver Services”. Alkema GE, Enguidanos SM, Wilber KW, Trufasiu M, Frey
D. . The Consultant Pharmacist. February 2009, Volume 24, No. 2
27
Always looking for new partnerships
Contact:
June Simmons, CEO
Partners in Care Foundation
818-837-3775
jsimmons@picf.org
www.picf.org
Bertha Sandoval
Partners in Care Foundation
818-837-3775 x134
bsandoval@picf.org
www.picf.org